Provider Demographics
NPI:1245511385
Name:WONG, ALICE (OD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 W STREET RD
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-3124
Mailing Address - Country:US
Mailing Address - Phone:215-347-1000
Mailing Address - Fax:215-773-8205
Practice Address - Street 1:966 W STREET RD
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-3124
Practice Address - Country:US
Practice Address - Phone:215-347-1000
Practice Address - Fax:215-773-8205
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002528152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist